Obesity (Weight Loss) (cont.)
What is the role of surgery in the treatment of obesity?
The National Institute of Health consensus has suggested the following
guidelines for surgery in obese patients:
- Patients with a BMI of greater than 40.
- Patients with a BMI of greater than 35 who have serious medical problems
such as sleep apnea, that would improve with weight loss.
A study done in Sweden compared the rates of diabetes and hypertension in two
groups of obese patients - those who underwent surgery and those who didn't.
Each group had similar body weight at baseline (the start of the study). At two
years, diabetes and high blood pressure were lower in the patients treated with
surgery.
Surgical procedures of the upper gastrointestinal tract are collectively
called bariatric surgery. The initial surgeries performed were the jejunocolic
bypass and the jejunoileal bypass (where the small bowel is diverted to the
large bowel, bypassing a lot of the surface area where food would have been
absorbed). These procedures were fraught with problems and are no longer
performed. Currently, procedures used include making the stomach area smaller or
bypassing the stomach completely.
In the cases of making the stomach smaller, vertically banded gastroplasty is
the most common procedure, where the esophagus is banded early in the stomach.
The other procedure is gastric banding, where an inflatable pouch causes gastric
constriction. Changing the volume in the ring that encircles the stomach can
change the amount of constriction.
Gastric bypass essentially causes weight loss
by bypassing the stomach.
The surgical treatment of obesity and the surgical procedures are evolving
constantly. Although these procedures are becoming more routine, the mortality
rate for these procedures is still between 0.5% and 2%.
The risks of surgery include the usual complications of infection,
blood
clots in the lower extremities (deep vein thrombosis) and in the lungs (pulmonary
embolism), and anesthesia risk. Specific
long-term risks related to obesity surgery include lack of iron absorption and
iron deficiency anemia. Vitamin B 12 deficiency can also develop and could lead
to nerve damage (neuropathies). Rapid weight loss may also be associated with
gallstones.
Next: Choosing a safe and successful weight-loss program »
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